Transcript File
The Organization of Home Care and the Nursing Assistant’s Role Standards • HS-NE-15: The student will analyze the role of the nursing assistant in the home health setting. a. Compare and contrast the nursing assistant role in home care to an acute or long-term care setting. b. Discuss procedure modifications for a home care setting c. Discuss how to promote safety and infection control in home care. How does HHC differ from in-facility care? • • • • • • • • 1. 2. 3. 4. 5. 6. 7. 8. Why the interest in home care? • Many factors bring home care back into the spotlight. – Expensive technology – DRG’s and earlier hospital discharge – Growing population of the chronically ill – Hospice care – Patient preference How does home care work? • It can be provided by governmentsponsored agencies, private agencies or hospital-sponsored agencies • LPNs RNs, CNAs, therapists and social workers are employed by home care agencies • Each agency is in charge of its own job description, salary, benefit and policies and procedures How does home care work? • Patients are referred from hospitals and nursing facilities • The patient/family chooses the home care provider • The discharge planner coordinates the care based on the physician’s orders • Payment for home care can come from Medicare, Medicaid, private insurance or personal funds • Care is “intermittent” because the care must be of a skilled nature—”sitting” with the patient or someone needed there for several hours is not considered skilled The Home Health Care Team • Client • Family • Nursing Assistant • Supervising Nurse • Physician • Other persons: – PT/OT/ST – Social worker – dietician The CNA is supervised by the RN. The nurse is responsible for the nursing care plan, which directs the patient’s care. The HHC team also has input in the treatment plan. Assessment • An assessment is completed during the first visit by the nurse • This provides for – Identifying the client’s problems – Determining approaches to resolve the problems – Establish goals – Evaluate for safety concerns – Determine the amount of time needed for each visit and length of time for services How do you avoid liability? • Know your job description, duties and responsibilities and do only your assigned tasks • Carry out procedures carefully • Ask for assistance if you are unsure how to do any procedures • Watch for safety hazards • Be familiar with client’s rights • Know how to contact the supervising nurse if needed • Know how and when to contact emergency services • Document your care and observations carefully • Participate in care conferences Recordkeeping • Time/travel records – Time of arrival and departure – Travel time – mileage • Client care records – – – – – Care given Client responses to care Housekeeping tasks completed Observations Long term reports (blood pressure, blood sugar) Documentation is very important and is completed as care is given. Time Management • You are responsible for planning your assignments and completing the client’s care within a certain amount of time • You may have several clients to see in one day – – – – – Have all supplies ready Organize your supplies Avoid distractions Call your next client if you are running late Avoid getting bogged down in tasks you are not expected to perform Working With Families • Remember the legal and ethical responsibilities • Cultural differences may play a role • Always answer questions objectively • Refer all medical questions to the doctor or the nurse • Use tact and courtesy • Use your time wisely The Nursing Process Continues • Assessment – Your observations regarding • Client’s response to care • Family interactions • Support that may be needed • Planning • Implementation – Any difficulties providing care • Evaluation – Be honest in the client’s progress – Accurately report your findings What does it take to be a home care CNA? • • • • Honesty Self-motivation Self-discipline Accuracy and an attention to details • Organization • Observational skills – Recognizing abnormal • • • • Maturity Insight Adaptability Acceptance of clients and their home • Ability to perform independently • Ability to make decisions • Ability to improvise!! Personal Safety • Know where you’re going • Bring essential items and lock belongings in the trunk • Wear proper uniform • Keep your gas tank full • Keep windows up and doors locked • Avoid parking on deserted streets or dark areas • Carry a cell phone for emergencies • Inform the client of your arrival time • Ask if joint visits can be arranged • Visit when family, etc are away if they cause problems • Attend self-defense classes If something doesn’t feel right, it probably is not. Home Health Care Duties • • • • • • • Helping with ADL’s ROM exercises Comfort measures Bathing Changing linen Maintaining safety Interacting with family members • Supervising client selfmedicate • Light housekeeping • Shopping for meals • Preparing meals • You do not do: – Heavy housework – Making decisions about food purchases – Getting involved with family disputes You can adapt or modify skills you perform in a health care facility to the home Safety in the home • Furniture obstacles – Scatter rugs – Unstable chairs • Repairs needed – Railings, stairs • Slippery surfaces • Fire safety – Extinguishers/alarms – Overloaded outlets – Electrical cords • Oxygen safety • Lock up if client is disoriented – – – – – – – – Chemicals Medications Small appliances Weapons Breakable items Smoking materials Power tools Aerosol cans Safety in the home • Medical alert bracelet • Living will or out-of-hospital code papers and where these are kept • Keep a list of emergency numbers next to the phone – – – – – – Agency number Always check for safety hazards Supervising nurse during your 1st Physician visit to the home. Family 911 Ambulance/fire/police/hospital if 911 not used in the area Does you client need… • You are not to reorganize the client’s home but to ensure safety – – – – Handrails in the bathroom Raised toilet seat Trapeze over bed Mechanical lift These must be ordered by the physician. Most insurance companies and Medicare will pay for them if needed. Discuss these with the nurse. Elder abuse • Abuse by family/relatives as stress and financial difficulties arise • Spousal abuse • Self-abuse by the client • It isn’t your job to determine if abuse happened, but it is your responsibility to report any signs or symptoms that may indicate abuse – – – – Statements of abuse Unexplained bruises or wounds Signs of neglect Change in personality Infection Control in the Home • • • • • • • • • • • Wash hands Keep bathroom and kitchen clean Care for food properly Dispose of tissues/wastes properly Clean up dirty dishes Dust daily Not allow clutter to accumulate Wear plastic apron Wear gloves (follow standard precautions) Use utility gloves for environmental cleaning Clean bathtubs after every use Housekeeping Tasks • • • • • Client’s room Bathroom Kitchen Food management Laundry • Plan food purchases with the nurse or family member • Carefully launder the client’s clothing according to the label Other Guidelines • Inform the nurse if there are any changes with the client – Eating, mobility, continence, adl issues • Watch for safety hazards and report any you see for a safety visit • When supervising the client taking meds – – – – Note expiration dates Should med be taken ac, pc, or with food Note if any OTC meds are taken Check pulse, BP, or glucose before meds is taken if indicated – Note if client is close to running out of med